Wednesday
Aug272014

What Is Amazon Up To? 

By Kim Bellard, August 27, 2014

Back in April, PwC and HRI issued a report that asked what new entrants might be healthcare's Amazon.com.  Now it appears that it might just be Amazon itself.

What we "know" is that unnamed "Amazon leadership" met in late July with Howard Sklamberg, FDA's deputy chief for global regulatory operations and policy, and other unnamed "various FDA leadership."

That's it; everything else is speculation.  Not much of a story perhaps, but, hey, without speculation there would be no point of blogs, and then I'd have to spend my time doing something else.

Still, the speculation is interesting, especially with a company like Amazon that has repeatedly demonstrated its ability to disrupt markets.

They already outsource their cloud services (Amazon Web Services, or AWS), their distribution capabilities, and their payment systems, the latter now being expanded to in-store payments, going up against the likes of Visa and Mastercard.  In a smartphone world dominated by Apple, Samsung and other established manufacturers, they fearlessly have introduced their own version, the Fire.  I could go on in various other spheres, but the point is clear -- they're not afraid of anyone.

So now health care?

Here are three ways that I would love to see if Amazon could add value to health care:

Reviews: OK, all you Amazon shoppers -- and there are a lot of us -- how many of you buy a product (even if not on Amazon) without first checking out the Amazon reviews?

Their reviews already cover various medical supplies/devices sold on Amazon, but wouldn't you love it if those reviews applied to, say, physicians or hospitals?

Recommendations: Amazon is noted for their personalized shopping recommendations, based on user's shopping and purchase history on the site and a lot of Big Data collaborative filtering.  Whether it is a recommended item, the "also viewed" products, or the "frequently bought together" combo suggestions, the recommendations are pretty effective in helping boost Amazon's sales.

Imagine if Amazon applied this to health care products, services, and even providers, recommending ones that they believe might best fit you, and possibly helping map out the various steps of a treatment plan (as they are "frequently bought together").

Medical tourism:  No, I don't mean the out-of-country packages of lower-cost health care services often thought of as medical tourism (although I'm not excluding them).  I mean more broadly making services or packages of something that consumers actively shop for, and breaking the traditional pick-the-closest doctor/hospital mindset that most consumers have gotten used to.

It's fun to speculate what Amazon might do, but the real benefit of them coming into health care in a bigger way would be that they might do something truly unexpected and unique, without health care industry blinders limiting their creativity.

They haven't asked for my advice -- and please feel free to get word to them that they should -- but what I'd urge Amazon

  • Keep it retail: Amazon made its reputation as a retail company, and yet health care has stubbornly resisted being truly retail -- Remember your roots!
  • Make people mad: I hope the AMA, AHA, and the state medical boards are furious, that individual health systems and health care professionals are scared to death, and there generally is a lot of arm-waving and teeth gnashing.

If everyone is applauding, Amazon didn't go far enough.

If all Amazon wants to do in health care is to make it easier for us to buy even more of the things we already buy too much of, and pay too much for, I wouldn't be surprised, but I will be disappointed.  We have plenty of companies who can help us tinker around the edges of the status quo, but all too few companies

Friday
Aug222014

Towers Watson 2014 Employer Survey Results

By Clive Riddle, August 22, 2014

Towers Watson has just released results from their annual Health Care Changes Ahead Survey which “offers insights into the focus and timing of U.S. employers’ plans and perspectives related to their health benefits, and their efforts to better manage costs and employee engagement.”

Their headline takeaway? “U.S. employers expect a 4% increase in 2015 health care costs for active employees after plan design changes… If no adjustments are made, employers project a 5.2% growth rate.

Towers Watson’s Randall Abbott tells us “in the current economic climate, affordability and sustainability remain dominant influences on employers’ overall health care strategies. Expense management and worker productivity are equally critical to business results. While employers are committed to providing health care benefits for their active employees for the foreseeable future, persistent concerns about cost escalation, the excise tax and workforce health have led to comprehensive strategies focused on both year-over-year results and long-term viability for health care benefits and workforce health improvement. The emphasis is on achieving or maintaining a high-performance health plan. And CFOs are now focused on a new gold standard: managing health cost increases to the Consumer Price Index. This requires acute attention to improving program performance.”

Here’s some key employer responses from their survey findings:

  • 73% of employers said they are somewhat or very concerned they will trigger the excise tax b
  • 43% said avoiding the tax is the top priority for their health care strategies in 2015.
  • 81% plan moderate to significant changes to their health care plans over the next three years
  • Pharmacy-only cost trend is projected to be 5.3% after plan changes (6% before changes)
  • 48% are considering tying incentives to reaching a specified health outcome such as biometric targets during the next three years ( 10% intend to adopt it in 2015)
  • 37% are considering offering plans with a higher level of benefit based on the use of high-performance or narrow networks during the next three years (7% in 2015)
  • 34% of employers are considering telemedicine during the next three years (15% in 2015)
  • 33% are considering significantly reducing company subsidies for spouses and dependents during the next three years (10% have already done so; 9% intend to do so in 2015)
  • 26% are considering spouse exclusions or surcharges if coverage is available elsewhere during the next three years; (30% already do so; 7% expect to add it in 2015)
  • 30& are considering caps on health care coverage subsidies for active employees, using defined contribution approaches during the next three years (13% already have them; 3% are planning them for 2015)
  • 50% are considering full-replacement ABHPs (Account Based Health Plans) during the next three years: (17% offer only an ABHP today; 4% intend to do so for 2015, and another 28% are considering it for 2016 or 2017)
  • 76% are exploring the use of personalized digital technologies, including mobile health applications and fitness wearables

Towers Watson included a number of questions measuring the private health insurance exchange opportunity:

  • 28% have extensively evaluated the viability of private exchanges
  • 24% said private exchanges could provide a viable alternative for their active full-time employees in 2016.
  • 64% said evidence private exchanges can deliver greater value than their current self-managed model would be a top decision factor
  • 34% said adoption of private exchanges by other large companies in their industry would be a top decision factor
  • 26% said an inability to stay below the excise tax ceiling as 2018 approaches would be a top decision factor
  • 99.5% have no plan to exit health benefits for active employees and direct them and their families to public exchanges, with or without a financial subsidy.
  • 77% are not at all confident public exchanges will provide a viable alternative for their active full-time employees in 2015 or 2016.

Of course it should be noted Towers Watson has their own private exchange product, OneExchange, that serves more than 1,100 employer clients with active employee and retiree options. Towers Watson just announced that during “the first half of 2014, 45 major U.S. employers launched OneExchange for full-time, part-time or retired employees. This is the largest number of employer implementations outside the typical fall enrollment period in the private exchange’s eight years of operation.” Major new clients they listed included GameStop; International Paper; Northrop Grumman; and the State of Rhode Island.

Friday
Aug152014

Ten Things to Know About Ebola Today:

Clive Riddle, August 15, 2014

While Ebola is only rampant in Africa, cases are now out-migrating, and Ebola is finally starting to get the increased  attention of the world it needs.  For those of us half a world away, we typically want to condense this information down to how it might ultimately indirectly or directly affect us. Unfortunately, some of that attention is overly shaped by fear, misinformation or even political agendas.

The CDC is a great resource site on Ebola Hemorrhagic Fever ,  including Ebola Virus Disease Information for Clinicians in U.S. Healthcare Settings.  NPR has a post today interviewing Jeanine Thomas, on why the Ebola decision has relevance for the U.S. health care system.  Much of the dilemma in West Africa is due to their lack of healthcare resources compared to more industrialized nations, as discussed in a Science Daily article posted yesterday, Ebola outbreak highlights global disparities in health-care resources, which pulls from NIH and New England Journal of Medicine content.

Perhaps a best first step for non-clinicians in the business of healthcare, is to become more conversant in the current state of affairs for Ebloa. As Lee Norman, MD, chief medical officer for The University of Kansas Hospital, reminds us, “the current Ebola Virus Disease is the deadliest on record but it is important to understand key elements of this virus. He and the University of Kansas Hospital have just released an excellent summary in the regard: 10 things to know about Ebola, we’ll repeat in its entirety:

  1. Cases Are Out-Migrating From Africa: This is happening due to the fact that infected or ill people are traveling out of those countries in Africa with Ebola outbreaks. Cases found outside of Africa may likely go up as the number of people leaving outbreak areas increases when aid-workers and others return to their home countries.
  2. No Cases of Human-to-Human Transmission Outside of Africa: There has been no human-to-human or other transmission to humans outside of Africa.
  3. Ebola Is Not Transmitted By Air, Only Via Bodily Secretions: Ebola is not respiratory, so it is not transmitted through coughing or breathing. These infections are occurring because of people who are exposed to bodily fluids of infected individuals.
  4. Ebola Is Not The Most Infectious Disease: As infectious diseases go, Ebola virus isn't inherently the most infectious nor is it the least infective from person-to-person. Measles and chickenpox, for example, are easier to spread. So are influenza and MERS.
  5. High Mortality Rates Due to Geography: The mortality rate is quite high in Africa Ebola cases, partly because of the chaos, instability, and unrest of the governments there, and very directly related to the fact that their access to standard treatment supplies (IV solution, tubing, syringes, and protective equipment) is not universally available. Ebola cases identified and treated in westernized nations, and those with modern infection control practices, will have a much lower rate than those seen in most African regions.
  6. Likelihood of Breakouts In Areas Outside of Africa: Meticulous infection control practices in modern hospitals will make it more unlikely that human-to-human transmission will occur in these settings. While expensive and advanced bio-containment units provide the highest level of infection control, it is unlikely that these units will be widespread throughout the world.
  7. No Approved Immunizations and Treatments: There are no approved immunizations to prevent Ebola virus infection. There are no approved treatments for Ebola virus infection. There are experimental antibody treatments, as well as an antiviral medication not approved for Ebola. But whether either or both are safe or effective for widespread use is not known. "Compassionate use" or "experimental use" of the above treatments is tempting, because no targeted, specific "conventional treatment" exists. But widely adopting experimental, unproven medications as "the new conventional therapy" has its own difficulties: Is it safe? Is it effective? Is it costly? Are there unanticipated "down-sides" to using them? A WHO ethics panel has given the go-ahead for this, something it has never done before.
  8. How Animals Play a Role: The non-human vectors that can harbor Ebola virus (fruit bats, non-human primates) are widespread in areas far removed from Africa. As such, it bears watching whether those vectors begin to harbor the virus. The WHO has an excellent map showing the parts of the world with these vectors.
  9. Alert Levels: The WHO and CDC both recently increased their respective alert levels. State and local health departments throughout the U.S. and world will certainly seek guidance as to the adoption of best "local practices" to guide hospital and care providers. The guidance by the CDC as to how to manage exposed individuals and those who might be incubating the infection are quite specific and helpful. They will certainly change as time goes on.
  10. What We Don't Know About Ebola: There are things unknown about Ebola. For example:
  1. Can a person have had a low-level infection and not know they ever had it? Probably, based on serum testing.
  2. Does a person who has had it and survived develop lifelong immunity? That is unknown at this point. The various strains of Ebola are enough different antigenically that there may not be cross-immunity.
  3. Is there such a thing as a "chronic carrier state" in humans where a person can shed the virus and be infectious for a long period of time, even when they themselves have no illness or symptoms? That is also unknown at this point.
Tuesday
Aug122014

The $10 Billion Search for Healthcare Innovation

By Claire Thayer, August 12, 2014

The hunt is on for the discovery of innovative ideas to change the delivery of health care at all levels.   Kaiser Health News published a great summary of this massive quest in this article: Washington's $10 Billion Search For Health Care's Next Big Ideas.  Funded by the new health care law, experiments are taking place in every state in the country with oversight provided by the newly created Center for Medicare and Medicaid Innovation.  Kaiser Health News tells us that the center’s ten-year, $10 billion budget is the largest ever devoted to transforming care. In several states the office is working to overhaul medicine for nearly all residents — not just those with government Medicare and Medicaid coverage.

In addition to seeking out new payment and service delivery models, Congress has defined – both through the Affordable Care Act and previous legislation – a number of specific demonstrations to be conducted by CMS and categorizes these Innovation Models into seven areas:

  • Accountable Care
  • Bundled Payments for Care Improvement
  • Primary Care Transformation
  • Initiatives Focused on the Medicaid and CHIP Population
  • Initiatives Focused on the Medicare-Medicaid Enrollees
  • Initiatives to Speed the Adoption of Best Practices
  • Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models

So far, the American Hospital Association has received $75.8 million towards it’s innovation initiatives, Johns Hopkins Univeristy has received $32 million, followed by several others receiving close to $25 million. Here’s a look at the Top 10 Recipients of the new Innovation Dollars:

week, HealthSprocket, the home for healthcare lists of all kinds, featured a couple of its recent lists on health care innovation:

If you’re looking for an easy way to stay current on healthcare innovation trends and initiatives, Health Policy Publishing has a new monthly newsletter, Healthcare Innovation News, dedicated solely to this topic, with feature articles contributed by leading national experts and executives in the field; Thought Leader insights; Industry Briefs; profile of a key individual involved with healthcare innovation initiatives; plus more.

Readers can get a free sample issue of the 12-page monthly Healthcare Innovation News publication here. And, if you’re simply wanting to stay in the loop on news and other general announcements pertaining to healthcare innovation, the bimonthly Healthcare Innovation Bulletin, also available from Health Policy Publishing, is accessible for free here, at any time.

Friday
Aug082014

Healthcare Workers Are More Confident About Their Prospects and the Future

by Clive Riddle, August 8, 2014

Randstad Healthcare, the national healthcare staffing firm, issues a quarterly report on healthcare workers’ confidence, conducted by Harris Poll, based on a survey of physicians, nurses, healthcare administrators and other healthcare professionals. Their just released second quarter 2014 report, which tells us that confidence is up for the second quarter in a row, and that healthcare workers had the highest level of confidence compared to all industries they track.

So what does that mean, that healthcare workers are increasing in confidence, are more confident than other workers, and what exactly is it that they are confident about?

The Randstad Healthcare Employee Confidence Index is a composite of various confidence measures via an online survey. The questions asked address their optimism regarding:

  • Their current employers’ outlook
  • Ability to find a new job
  • Likelihood of retaining existing job
  • Availability of other jobs
  • Strength of the economy

Key survey findings for healthcare workers included:

  • 71% have confidence in the future of their current employer, compared to 54% in the previous quarter.
  • 61% have confidence in their ability to find a new job (same as previous quarter)
  • 81% say it is not likely they will lose their jobs in the next 12 months, compared to 72 percent in Q1 of this year.
  • 28% are likely to look for a new job, compared to 33% in Q1, and 46% in Q4 2013.
  • 44% believe fewer jobs are available (compared to 48% previous quarter). 61% are confident they could find a job in the next 12 months.
  • 31% say the economy is getting stronger (compared to 29% previous quarter). 33% believe the economy is staying the same, and 37% believe it is getting weaker

Given all the political hubbub about the health care reform, it’s interesting to see that the pivotal ACA implementation year of 2014 actually brought a rise in confidence about job prospects, sector economic strength sand overall economic outlook, for those working directly in the industry. Perhaps this means that insiders don’t view the ACA as all doom and gloom.